Malaria control in Malawi: are the poor being served?
Background: In Africa, national governments and international organizations are focusing on rapidly “scaling up” malaria control interventions to at least 60 percent of vulnerable populations. The potential health and economic benefits of “scaling up” will depend on the equitable access to malaria control measures by the poor. This paper analyses the present inequalities in access to malaria interventions in Malawi. Methods: Equity in access to malaria control measures was assessed using the Malawi Demographic Health Survey (DHS) 2000 and the 2004 National Survey on Malaria Control. Utilisation of malaria control methods was compared across the wealth quintiles based on asset scores found in the DHS. For the 2004 national data set, principal component analysis was used to create quintiles, to determine whether the poor were being reached with malaria control measures. Results: Although significant progress has been made in the use of insecticide treated nets and intermittent preventive treatment during pregnancy, these effective malaria control interventions remain inaccessible to the poor. Effective treatment of fever remains unacceptably low with only 17% of the under-five children being promptly treated with an effective antimalarial drug. Conclusions: The present distribution strategies for malaria control interventions are not addressing the needs of the vulnerable groups, especially the poorest of the poor. However, increasing access to malaria interventions by the poor will require government and community commitment to malaria control and donor support to underwrite the cost of the interventions.
Malawi Medical Journal Vol. 18 (1) 2006: pp. 28-32